Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study.

BACKGROUND: Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. OBJECTIVE: Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. METHODS: We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities. RESULTS: Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. CONCLUSIONS: The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.

The Effect of COVID-19 on hotel booking intentions: Investigating the roles of message appeal type and brand loyalty.

The unprecedented global health concerns pertaining to COVID-19 have impacted the hotel industry. In order to ameliorate such concerns, hotels are sending out marketing communication messages. However, whether the messages effectively impact hotel consumers' behaviors is still unknown. To fill this research gap, this study empirically tested the effect that the perceived severity of COVID-19 (PSC) has on hotel booking intentions as well as the roles of message appeal type (rational vs. emotional) and brand loyalty. The data was collected using a scenario-based online survey (n = 311) and analyzed using hierarchical multiple regression. The rational appeal type had a greater positive influence on hotel booking intentions, which suggests that it is preferable for COVID-19 related messages. The results also indicated that PSC had a negative influence on booking intentions for the low loyalty group, and brand loyalty still played a key role even amidst the COVID-19 crisis.

Effect of late antenatal booking on maternal anemia and fetus birth weight on parturients in Enugu, Nigeria: An analytical cross-sectional study.

Background: The benefits of antenatal care are maximized when women book early for care. However, despite these resounding benefits, women still book late, while others do not book at all, resulting in dire feto-maternal consequences. Aim: Determine the effect of late prenatal booking on maternal anemia and birth weight in babies of women who delivered in public health facilities in Enugu and deduce the reasons for booking late. Patients and Methods: A cross-sectional study of two groups of women (235 participants in each group) who delivered in 4 randomly selected hospitals in Enugu. Descriptive statistics were obtained for continuous variables, and frequency and percentages were used for categorical variables. Degree of associations was determined using the Chi-square, the student's t-test, and 2 x 2 table. Results: The prevalence of anemia among women that booked late and early were (69.7%; n = 147) and (50.7%; n = 107) respectively. Women who booked late were two times more likely to have anemia than those who booked early (OR = odds ratio, p = p-value, CI = confidence interval,). Those who booked late were six times more likely to deliver low birth weight babies than those who booked early (OR = 5.934, 95% CI = 1.299-27.119, P = 0.022). Conclusions: Late prenatal booking is associated with a high prevalence of maternal anemia in labor, low mean maternal hemoglobin, and low birth weight compared to those of women who booked early and the reasons for booking late are multifactorial.

Non-booking for antenatal care and risks for vertical HIV transmission among women in Chitungwiza, Zimbabwe: a cross-sectional study.

BACKGROUND: The success of prevention of mother to child transmission of HIV (PMTCT) programs dependents on pregnant women accessing antenatal care (ANC) services. Failure to access ANC throughout the course of pregnancy presents a missed opportunity to fully utilize PMTCT services and a high risk for vertical HIV transmission. Whilst not booking for ANC was about 6% in Zimbabwe, according to the 2015 Zimbabwe Demographic and Health Survey, it is important to determine the local burden of pregnant women both un-booked for ANC and living with HIV. in Chitungwiza city, to inform local response. This study aimed at determining the proportion of women un-booked for antenatal care and among them, the proportion of women who were with HIV and to identify risk factors associated with not-booking for ANC in Chitungwiza city in Zimbabwe. METHODS: A cross-sectional study was conducted involving a review of clinic records for 4400 women who received postnatal care at all 4 maternity clinics in Chitungwiza city between 01 January 2017 and 31 December 2017. Bivariate and multiple logistic regression analysis with Chi squared test were used to determine risk factors associated with booking status while adjusting for other study variables. All statistics tests' decisions were concluded at 5% level of significance. All data analysis was performed using STATA (version 13) statistical package. RESULTS: A total of 4400 women were attended to and of these, 19% were un-booked for ANC, while a total of 3% of the women were both un-booked and living with HIV. The women with HIV were 0.24 times less likely to book for ANC than HIV negative women, adjusted OR = 0.76 (95% CI: 0.61-0.98). Women aged 20-34 years were 1.3 times more likely to book than the teenagers, adjusted OR = 1.3 (95% CI: 1.04-1.62). CONCLUSION: The proportion of women not booked for ANC of 19% was unexpectedly high. With 3% of pregnant women in Chitungwiza having both HIV and no access to ANC, the risk for vertical HIV transmission remains. More need to be done to improve ANC access, targeting teenage mothers and those living with HIV who are more less likely to access ANC.

Perception of pregnant women towards early antenatal visit in Fiji: a qualitative study.

BACKGROUND: Antenatal Care (ANC) is an opportunity to provide care to prevent potential maternal and new born mortality and morbidity and reduce new born mortality and morbidity. There has been an increase in the number of women receiving early ANC over the last two decades, however, in many developing regions such as Fiji, women are still delaying initiation of ANC. Therefore, the aim of this study is primarily to explore reasons for delayed initiation of ANC appointments and to explore knowledge and perception of pregnant mothers towards early antenatal appointments in Fiji. METHODS: The study uses a qualitative approach. Data was collected among pregnant women more than 18 years of age after 12 weeks of gestation attending their first ANC clinic at the Ba Mission Hospital (BMH) from February 28 to April 2, 2020. Heterogenous purposeful sampling method was used to select 25 pregnant women for the study. A semi-structured open-ended questionnaire was used for face to face in-depth interviews. Data was analyzed manually using thematic content analysis after verbatim transcription of the interviews. RESULTS: The mean age of the participants was 25.8 ± 5.9 years (age range of 19-40 years). The average gestational age of those making a booking for a consultation was 5.4 ± 1.4 months with a range of 4 to 8 months. The majority of women were multigravida (64%) and multiparous (40%). The main themes that emerged from the study were: i) perception of early ANC booking; ii) perceived barriers of early ANC booking and; iii) enabling factors of early ANC booking. Even though pregnant women have a good knowledge of when to initiate ANC, the practice of early booking was influenced by many other factors. CONCLUSIONS: The results of this study highlight the need to change the current booking system. Efforts are needed to attract the hard-to-reach women through outreach visits and increased communication between health care workers and the community with the use of community resources such as community health workers and traditional birth attendants. The media should be used to create awareness on timing and importance of early ANC visits at a community level.

Adherence to appointments for gestational diabetes testing and experiences with two-hour postprandial glucose test: a mixed-methods study in Ghana.

BACKGROUND: Failure to attend scheduled appointments is a common problem in healthcare. In obstetrics, diagnostic and treatment protocols for gestational diabetes mellitus (GDM) require client booking, test preparations, management and follow-up reviews. We identified the socio-demographic, obstetric and medical drivers influencing adherence to appointments for GDM testing and experiences of pregnant women's regarding performing oral glucose tolerance test (OGTT). METHODS: A convergent parallel mixed-methods study comprising a cross-sectional survey and an explorative qualitative descriptive design were used. We recruited 817 women in their first trimester of pregnancy from the antenatal clinics of primary, secondary and tertiary health facilities in Ghana. After obtaining their demographic and health history, we scheduled them for 2-h OGTT between 24 and 28 gestational weeks and estimated the odds of returning for the test. In the qualitative phase, we called 166 participants to ascertain why they failed to report. Also, we had in-depth and focused group discussions with 60 postpartum women who performed the OGTT to explore their experiences with the test. RESULTS: Out of 817 pregnant women scheduled, 490 (59.97%) reported of which 54.59, 54.33 and 53.24% completed fasting plasma glucose, 1-h and 2-h OGTT, respectively. Maternal age above 35 years (OR: 3.56, 95% CI:1.49-8.47), secondary education (OR: 3.21, 95% CI: 1.19-8.69), formal sector employment (OR: 2.02, 95% CI: 1.16-3.51) and having same-sex children (OR: 4.37, 95% CI: 1.98-9.66) increased odds of appointment adherence whereas healthcare in a tertiary hospital (OR:0.46, 95% CI:0.22-0.96), rural residence (OR: 0.53, 95% CI: 0.34-0.85) and being overweight (OR: 0.45, 95% CI: 0.25-0.78) decreased the likelihood. Experiences were thematized into feelings about test procedure, acceptability of test, skillfulness of the health workers and information on the test. Despite the apprehension and discomforts associated with the test, the desire to know one's disease status was the chief motivation. Empathy, reassurance and receiving ample information on the test procedures eased anxiety and improved test compliance. CONCLUSIONS: Although 40% of participants scheduled did not return, the test was generally acceptable. Socio-cultural underpinnings influenced the health-seeking behaviors, meaning that health worker interactions on test procedures need to be sensitive to the woman's situation.

'I fear my partner will abandon me': the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda.

BACKGROUND: Many women in sub-Saharan Africa initiate antenatal care (ANC) late in pregnancy, undermining optimal prevention of mother-to-child-transmission (PMTCT) of HIV. Questions remain about whether and how late initiation of ANC in pregnancy is related to adherence to antiretroviral therapy (ART) in the era of national dolutegravir roll-out. METHODS: This study employed a qualitative design involving individual interviews and focus group discussions conducted between August 2018 and March 2019. We interviewed 37 pregnant and lactating women living with HIV selected purposively for early or late presentation to ANC from poor urban communities in South Africa and Uganda. Additionally, we carried out seven focused group discussions involving 67 participants in both countries. Data were analysed thematically in NVivo12. RESULTS: Women described common underlying factors influencing both late ANC initiation and poor ART adherence in South Africa and Uganda. These included poverty and time constraints; inadequate health knowledge; perceived low health risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes. Most late ANC presenters reported relationship problems, lack of autonomy and the limited ability to dialogue with their partners to influence household decisions on health and resource allocation. Perception of poor privacy and confidentiality in maternity clinics was rife among women in both study settings and compounded risks associated with early disclosure of pregnancy and HIV. Women who initiated ANC late and were then diagnosed with HIV appeared to be more susceptible to poor ART adherence. They were often reprimanded by health workers for presenting late which hampered their participation in treatment counselling and festered provider mistrust and subsequent disengagement in care. Positive HIV diagnosis in late pregnancy complicated women's ability to disclose their status to significant others which deprived them of essential social support for treatment adherence. Further, it appeared to adversely affect women's mental health and treatment knowledge and self-efficacy. CONCLUSIONS: We found clear links between late initiation of ANC and the potential for poor adherence to ART based on common structural barriers shaping both health seeking behaviours, and the adverse impact of late HIV diagnosis on women's mental health and treatment knowledge and efficacy. Women who present late are a potential target group for better access to antiretrovirals that are easy to take and decrease viral load rapidly, and counselling support with adherence and partner disclosure. A combination of strengthened health literacy, economic empowerment, improved privacy and patient-provider relationships as well as community interventions that tackle inimical cultural practices on pregnancy and unfair gender norms may be required.

Characteristics and Predictors of Late Antenatal Booking Among Pregnant Women in Fiji.

OBJECTIVE: Antenatal Care (ANC) plays a pivotal role in improving child and maternal health. Even though antenatal coverage in Fiji is more than 95%, the majority of pregnant women fail to initiate ANC within the first trimester. Thus, the research aimed to determine factors that are associated with late antenatal booking among pregnant women who delivered in Ba Mission Hospital (BMH) in Fiji in 2019. METHODS: Secondary data analysis was done using SPSS version 24 on 340 pregnant women who had delivered in BMH from January 1 to December 31, 2019 and met the eligibility criteria. A data extraction sheet was used to collect information on socio-demographic, obstetric, and medical factors. RESULTS: The prevalence of late booking in BMH in 2019 was 79.7%. The results of the bivariate analysis showed that being from I-taukei ethnicity (AOR: 2.36; p = 0.003), an unmarried woman (AOR: 2.5; p = 0.004), and women with < eight ANC visits (AOR: 3.7; p < 0.001) during the pregnancy were significant predictors of late antenatal booking. Multivariate analysis showed that only < eight ANC visits were a significant determinant of late antenatal booking (COR: 3.6; p < 0.001). CONCLUSION: The burden of late antenatal booking in Ba is higher than those of some other developing nations. Efforts are needed to create community awareness on the importance of early ANC booking. The significant factor identified should inform policymakers on how to influence pregnant women to come for an early booking for ANC.

Prevalence and risk factors for anaemia among pregnant women attending antenatal clinic at Benue State University Teaching Hospital, North-central Nigeria.

In developing countries such as Nigeria, anaemia in pregnancy is thought to be one of the most common complications of pregnancy accounting for a significant level of maternal morbidity and mortality. The aim of this study was to determine the prevalence of anaemia in pregnancy among women attending the booking Antenatal Clinic (ANC) in Benue State University Teaching Hospital (BSUTH), North-Central, Nigeria. A cross-sectional descriptive study was conducted from May 2019 to January, 2020 on 299 women. A structured interviewer administered questionnaire was used to obtain socio-demographic, clinical, and nutritional information from pregnant women attending the clinic who consented to participate in the study. Haematocrit levels were stratified according to the World Health Organisation's (WHO) classification as follows: <7mg/dL - severe, 7-8.99mg/dL - moderate, 9-10.99mg/dL - mild anaemia and ≧ 11mg/dL - non-anaemic. Data were analysed using SPSS version 25.0. Chi-square test was conducted to determine relationships. Multivariate logistic regression model was used to identify the risk factors for anaemia among pregnant women. P-value <0.05 and odds ratio with a 95% confidence interval were used to assess the association. The mean age of respondents was 29.9, ranging from 18 - 40 years. One hundred and twenty-three (41.1%) women were anaemic (haemoglobin [Hb] < 11.0 g/dL). The majority (95.1%) of these anaemic patients were mildly anaemic, whereas 4.9% were moderately anaemic. There was no case of severe anaemia (Hb < 7.0 g/dL). The prevalence of anaemia was significantly higher in those within the age group of 20-24 years and those with lower levels of education (P < 0.05). The patient's gestational age, number of miscarriages and birth interval had no significant relationship with the haemoglobin concentration among the pregnant women in this study (P > 0.05). However, parity, clinical features such as fever, and practices like use of haematinics and non-consumption of meat, poultry and fish were significantly related to anaemia (P < 0.05). The pregnant women who did not take haematinics were 5.8 times likely to develop anaemia (OR=5.8, 95%CI [2.3, 14.5]) while pregnant women who did not eat meat, poultry or fish were 9 times more likely to become anaemic than pregnant women who ate (OR=9.0, 95%CI [1.0, 79.5]). The prevalence of anaemia in pregnancy is high among women attending booking antenatal clinic at BSUTH, North-Central, Nigeria, and requires specific intervention that address the identified risk factors.

COVID-led consumption displacement: A longitudinal analysis of hotel booking patterns.

This research contributes to the literature on consumption displacement by exploring the pandemic-led shifts in hotel booking patterns. We perform a longitudinal analysis and a critical comparison of bookings before and after COVID-19 outbreak, focusing on the booking window, length of stay, and booking channel. Data include weekly bookings of a representative sample of Balearic Islands' hotels between 2018 and 2021. Results indicate that the pandemic has led to a drop in the volume of bookings and a remarkable change in booking patterns. Specifically, we find a temporal shift in booking behavior, characterized by a lower anticipation and a change in the tourism supply chain, namely a decrease in the share of intermediated bookings. The expected increase in the frequency of exogenous shocks, such as weather-related and sanitary crises, could affect purchasing behaviors, thus enhancing the relevance of this study, with managerial implications for industry and destination managers.

Short-term rental market crisis management during the COVID-19 pandemic: Stakeholders' perspectives.

Contingency plans and crisis management strategies have been implemented by the short-term rental industry to deal with the COVID-19 pandemic. This paper examines the strategies adopted by three key groups of stakeholders: short-term rental platforms (e.g. Airbnb, Booking.com), service providers (represented by property management companies and short-term rental associations) and policymakers/tourism experts. The professional service providers, in particular, constitute a significant share of the short-term rental industry, but have not received much scholarly attention. In this respect, our study fills this gap by bringing attention to unexplored segments of the short-term rental industry. By examining and comparing the responses from these key groups, the paper contributes to the ongoing research about the workings of the short-term rental industry and its responses to the COVID-19 crisis.

The effect of threat and fear of COVID-19 on booking intentions of full board hotels: The roles of perceived coping efficacy and present-hedonism orientation.

This study proposes a novel theoretical model on the negative effect of the perceived cognitive threat and fear of COVID-19 on full board hotel booking intentions, which includes the moderating effects of perceived coping efficacy and present-hedonism orientation. The model was tested with a representative online sample (N = 400) of the Spanish population older than 35 years. The results confirmed negative effects of threat and fear of COVID-19 on hotel booking intentions, as well as a negative moderating effect of perceived coping efficacy on the influence of fear of COVID-19. However, coping efficacy did not moderate the effect of perceived cognitive threat on hotel booking intentions. The present-hedonism orientation positively affected full board hotel booking intentions, but did not, however, reduce the negative effect of threat or fear on those intentions. The findings provide new insights for hospitality managers that can contribute to accelerate the recovery of the hospitality industry.

The impact of hotel CSR for strategic philanthropy on booking behavior and hotel performance during the COVID-19 pandemic.

During the novel coronavirus (COVID-19) pandemic, some hotels have engaged in corporate social responsibility (CSR) activities to help overcome the crisis. Given that most existing research examines the impact of hotel CSR on a single stakeholder, how hotel CSR activities in a crisis are perceived by multiple stakeholders is unknown. Drawing on the concept of strategic philanthropy, this study examines the impact of hotel CSR activities during the pandemic, such as providing accommodations to healthcare workers, on hotel firms' market value and prospective hotel customers' booking behavior. Adopting mixed-methods approach, this study finds negative impacts of hotel CSR for strategic philanthropy on firm market value and customer booking behavior. The study result indicates that the value of hotel CSR depends on the nature and environmental contexts of CSR. Specific theoretical and practical implications are provided.

Preventing food waste in subsidy-based university dining systems: An artificial neural network-aided model under uncertainty.

Food waste planning at universities is often a complex matter due to the large volume of food and variety of services. A major portion of university food waste arises from dining systems including meal booking and distribution. Although dining systems have a significant role in generating food wastes, few studies have designed prediction models that could control such wastes based on reservation data and behavior of students at meal delivery times. To fill this gap, analyzing meal booking systems at universities, the present study proposed a new model based on machine learning to reduce the food waste generated at major universities that provide food subsidies. Students' reservation and their presence or absence at the dining hall (show/no-show rate) at mealtime were incorporated in data analysis. Given the complexity of the relationship between the attributes and the uncertainty observed in user behavior, a model was designed to analyze definite and random components of demand. An artificial neural network-based model designed for demand prediction provided a two-step prediction approach to dealing with uncertainty in actual demand. In order to estimate the lowest total cost based on the cost of waste and the shortage penalty cost, an uncertainty-based analysis was conducted at the final step of the research. This study formed a framework that could reduce the food waste volume by up to 79% and control the penalty and waste cost in the case study. The model was investigated with cost analysis and the results proved its efficiency in reducing total cost.

Case study of the prediction of elective surgery durations in a New Zealand teaching hospital.

We present an elective surgery redesign project involving several New Zealand hospitals that is primarily data-driven. One of the project objectives is to improve the predictions of surgery durations. We address this task by considering two approaches: (a) linear regression modelling, and (b) improvement of the data quality. For (a) we evaluate the accuracy of predictions using two performance measures. These predictions are compared to the surgeons' estimates that may subsequently be adjusted. We demonstrate using the historical surgical lists that the estimates from our prediction techniques improve the scheduling of elective surgeries by minimising the occurrences of list under- and over-runs. For (b), we discuss how the surgical data motivates a review of the surgery procedure classification which takes into account the design of the electronic booking form. The proposed hierarchical classification streamlines the specification of surgery types and therefore retains the potential for improved predictions.

Probability estimation model for the cancellation of container slot booking in long-haul transports of intercontinental liner shipping services.

The intercontinental liner shipping services transport containers between two continents and they are crucial for the profitability of a global liner shipping company. In the daily operations of an intercontinental liner shipping service, however, container slot bookings from customers can be freely cancelled during a booking period, which causes loss of revenue and low utilization of ship capacity. Though a pain-point of the liner shipping industry, the container slot cancellation problem has not yet been well investigated in the literature. To fill this research gap, this study aims to estimate the probability for the cancellation of container slot booking in the long haul transports of the intercontinental liner shipping service by considering the primary influential factors of cancellation behavior. To achieve the objective, a container slot booking data-driven model is developed by means of a time-to-event modeling technique. To incorporate the effect of booking region on the cancellation probability, we introduce the frailty term in the model to capture the regionality of the container shipping market. Our case study with real slot booking data shows that the developed model performs well in forecasting the loaded containers of the slot booking requests. In addition, we shed light on how the internal factors of slot booking and external factors of shipping market influence the probability of cancellation.

Reducing perceived health risk to attract hotel customers in the COVID-19 pandemic era: Focused on technology innovation for social distancing and cleanliness.

As an essential risk-reduction strategy, technology innovation is likely to play a key role in the hotel industry's recovery from the 2020 coronavirus pandemic. However, its impact on customer decision-making behavior is unknown. Focusing on technology innovation for reducing guest interaction with employees and enhancing cleanliness, the purpose of this research was to examine the impact of expected interaction and expected cleanliness on perceived health risk and hotel booking intention. Three experimental studies were conducted using online consumer samples. The studies found that low levels of expected interaction through technology-mediated systems lead to low levels of perceived health risk. Perceived health risk mediates the relationship between expected interaction and hotel booking intention. In addition, high levels of expected cleanliness through advanced cleaning technologies moderate the impacts of expected interaction on perceived health risk. Importantly, the proposed perceived risk mechanism was effective in post-pandemic scenarios. Theoretical and practical implications are discussed.

Improving accessibility for outpatients in specialist clinics: reducing long waiting times and waiting lists with a simple analytic approach.

BACKGROUND: Lack of resources is often cited as a reason for long waiting times and queues in health services. However, recent research indicates these problems are related to factors such as uncoordinated variation of demand and capacity, planning horizons, and lower capacity than the potential of actual resources. This study aimed to demonstrate that long waiting times and wait lists are not necessarily associated with increasing demand or changes in resources. We report how substantial reductions in waiting times/wait lists across a range of specialties was obtained by improvements of basic problems identified through value-stream mapping and unsophisticated analyses. METHODS: In-depth analyses of current operational processes by value-stream mapping were used to identify bottlenecks and sources of waste. Waiting parameters and measures of demand and resources were assessed monthly from 12 months before the intervention to 6 months after the intervention. The effect of the intervention on reducing waiting time and number of patients waiting were evaluated by a difference-in-differences analysis. RESULTS: Mean waiting time across all clinics was reduced from 162 + 69 days (range 74-312 days) at baseline to 52 + 10 days (range 41-74 days) 6 months after the intervention. The time needed to achieve a waiting time of 65 days varied from 4 to 21 months. The number of new patients waiting was reduced from 15,874 (range 369-2980) to 8922 (range 296-1650), and the number of delayed returning patients was reduced from 18,700 (310-3324) to 5993 (40-1337) (p < 0.01 for all). Improvement in waiting measures paralleled a significant increase in planning horizon. CONCLUSIONS: Significant improvements in accessibility for patients waiting for service may be achieved by applying unsophisticated methods and analyses and without increasing resources. Engagement of clinical management and involvement of front line personnel are important factors for improvement.

Socio-demographic predictors of unintended pregnancy and late antenatal booking in Honiara, Solomon Islands.

BACKGROUND: The Solomon Islands is a Pacific nation with a maternal mortality of 114 per 100 000 births. Around 57% of pregnancies are unintended and only 15% of women attend their first antenatal visit in the first 12 weeks as recommended by the World Health Organization. AIMS: We sought to examine the socio-demographic predictors of unintended pregnancy and late antenatal booking (>18 weeks) among women attending antenatal care in Honiara. MATERIALS AND METHODS: From January 2014 to May 2015 we undertook a cross-sectional survey using a structured questionnaire on women presenting to the National Referral Hospital and community clinics in Honiara for antenatal care. RESULTS: Of 1441 women, 41.0% of pregnancies were intended, 55.7% were ambivalent and 3.3% were fully unintended. Unintended pregnancy was significantly associated with being unemployed (adjusted odds ratio (aOR) 1.45, P = 0.024), being a teenager at first intercourse (aOR 1.53; P = 0.004), shared family planning decision making (aOR 0.54; P = 0.006) living with a husband (aOR 0.31 P < 0.001) and a short interpregnancy interval (OR 4.48, P ≤ 0.001). Late booking occurred in 1168 (84.7%) women and independent predictors of this included ambivalent or unintended pregnancy (aOR 1.74, P = 0.005) and multiparity (aOR 2.05, P = 0.001). CONCLUSIONS: Unintended pregnancy and late antenatal booking remain a challenge to improving maternal health in the Solomon Islands. Investments in family planning could target reproductive health education and post-partum family planning. Improving the quality of antenatal care as well as addressing social determinants of health, including gender equity, education and employment of women, is required if maternal mortality is to be reduced.

Screening and Treatment for Early-Onset Gestational Diabetes Mellitus: a Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: We conducted a systematic review to evaluate the current evidence for screening and treatment for early-onset gestational diabetes mellitus (GDM) RECENT FINDINGS: Many of the women with early GDM in the first trimester do not have evidence of hyperglycemia at 24-28 weeks' gestation. A high proportion (15-70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. However, there remains no good evidence for any of the diagnostic criteria for early-onset GDM. In a meta-analysis of 13 cohort studies, perinatal mortality (relative risk (RR) 3.58 [1.91, 6.71]), neonatal hypoglycemia (RR 1.61 [1.02, 2.55]), and insulin use (RR 1.71 [1.45, 2.03]) were greater among early-onset GDM women compared to late-onset GDM women, despite treatment. Considering the high likelihood of benefit from treatment, there is an urgent need for randomized controlled trials that investigate any benefits and possible harms of treatment of early-onset GDM.